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Abstract: Slide Presentations |

Reducing Corticoidsteroid Administration Decreases The Incidence Of Opportunistic Infection Following Lung Transplantation Without Increasing Early Rejection FREE TO VIEW

Sachin H. Shah, MD*; Wickii T. Vigneswaran, MBBS; Sangeeta Bhorade, MD; Edward Garrity, MD; Jaime Villanueva, MD
Author and Funding Information

Loyola University Medical Center, Maywood, IL


Chest


Chest. 2004;126(4_MeetingAbstracts):712S-c-713S. doi:10.1378/chest.126.5.1714-a
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Abstract

PURPOSE:  Advances in immunosuppressive regimens have decreased the incidence of early graft rejection following lung transplantation. Despite the common use of antimetabolites, monoclonal antibodies, calcineurin inhibitors and IL-2 inhibitors in immunosuppressive protocols, high dose corticosteroids are also routinely administered. We hypothesize that reduction in corticosteroid administration will decrease opportunistic infection following lung transplantation.

METHODS:  Two groups of lung transplant recipients were compared in a retrospective review. Group 1 (n=26) received one gram of methylprednisolone prior to reperfusion of the transplant lung followed by three doses of 125 mg each over 24 hours. Group 2 (n=27) received only 500 mg of methylprednisolone prior to reperfusion. All patients underwent induction with daclizumab (1mg/kg) and were maintained with azathioprine (2mg/kg ), tacrolimus (0.04mg/kg, desired blood levels 10-20ng/ml), and prednisone (0.5 mg/kg/day, beginning POD 2) following transplantation. The two groups were compared with regard to patient survival, rejection episodes, and infectious complications at six months.

RESULTS:  The two groups were comparable with regards to age, sex, transplant procedure, and cytomegalovirus (CMV) match. Episodes of rejection and patient survival were similar at six months post-transplant. Patients in Group 1 developed more opportunistic infections than patients in group 2 (50% vs 22% respectively, p = 0.06). No difference in the incidence of CMV infection was apparent, however patients in Group 1 developed more fungal and bacterial infections than patients in Group 2 (35% vs 7.4%, p = 0.03).

CONCLUSION:  Reducing peri-operative steroid administration lowers infectious complications following lung transplantation. This benefit is realized without increasing the incidence of early rejection.

CLINICAL IMPLICATIONS:  Opportunistic infectious complications following lung transplantation remain a major contributor for morbidity and mortality following lung transplantation. Manipulation of peri-operative steriod dosing appears to significantly affect opportunistic infections following lung transplantation and may contribute to reduction in morbidity associated with steriod usage.

DISCLOSURE:  S.H. Shah, None.

Monday, October 25, 2004

10:30 AM- 12:00 PM


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